- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring...+ Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical… more
- Stanford Health Care (Palo Alto, CA)
- …ASA + Knowledge of medical management statistics relating to UM/CM and prior authorization process management. + Extensive knowledge of risk stratification ... Care **What you will do** + Inpatient & SNF Utilization Management & Care Coordination: + Support proactive hospital...Compact State Licensure . + CCM - Certified Case Manager preferred . **These principles apply to ALL employees:**… more
- Stony Brook University (Stony Brook, NY)
- …with the transferring hospital, Patient Access and physicians and payers for authorization prior to transfer from other hospitals. + Consistent documentation ... RN Case Manager **Position Summary** At Stony Brook Medicine, a...the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity… more
- CRST (Cedar Rapids, IA)
- …the flexibility of a private fleet, without the expense. **The Role** The Fleet Manager is responsible for overseeing all aspects of a fleet of trucks. Their main ... Wages (Pay Bi-Weekly) *A final amount is dependent on factors including prior relevant experience, knowledge, and location. Typically, selected candidates are hired… more
- CRST (Lacey, WA)
- …the flexibility of a private fleet, without the expense. **The Role** The Fleet Manager is responsible for overseeing all aspects of a fleet of trucks. Their main ... Wages (Pay Bi-Weekly) *A final amount is dependent on factors including prior relevant experience, knowledge, and location. Typically, selected candidates are hired… more
- Luke Staffing (Yigo, GU)
- …TRICARE benefit for approval. + Ensures Line of Duty paperwork is on file prior to authorization . + Verify eligibility of beneficiaries using Defense Eligibility ... of clinical nursing experience is required. One year of previous experience in Utilization Management is required. Full time employment in a nursing field within the… more
- CVS Health (Baton Rouge, LA)
- …with heart, each and every day. **Position Summary** The Utilization Management Manager of Prior Authorization oversees a team of clinical professionals ... + Lead, coach, and develop a multidisciplinary team responsible for utilization review, prior authorization , and case management functions. + Monitor team… more
- University of Miami (Miami, FL)
- …initial, concurrent and retrospective chart reviews for clinical utilization and authorization . The Utilization Review Case Manager coordinates with the ... Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to...Adhere and perform timely prospective review for services requiring prior authorization as well as timely concurrent… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... ) required or completed within three years of hire **Title:** * Manager - Utilization Review* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
- Fallon Health (Worcester, MA)
- …Registered Nurse in a clinical setting required. * 2 years' experience as a Utilization Management/ Prior Authorization nurse in a managed care payer ... **This is 3 months temporary contract position for a Prior Authorization RN.** **About us:** Fallon Health...Keeps records and submits reports as assigned by the Manager * Refers high-risk cases to the appropriate FH… more
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